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Friday, January 2, 2009

On Dec. 22, 2008, Benedict Carey published an article online in The New York Times with the title "Blind, Yet Seeing: The Brain’s Subconscious Visual Sense" in which he describes a recent demonstration of blindsight. Researchers in Switzerland reported a remarkable performance of a patient who had recovered from a massive stroke that completely destroyed the visual areas of cerebral cortex on both hemispheres (de Gelder and others, 2008). Despite this impediment the patient successfully managed to negotiate an obstacle course set out for him in a hallway. Already 60 years ago, the eminent American neuroscientist Karl Lashley observed in a series of meticulous cortical ablation experiments that decerebrated rats were able to wend their way through their environment with surprising competence.

Nerve cells in a midbrain structure known as superior colliculus may play a crucial role in this process. When the cortical hemispheres of our brain are parted at the midline, the observer recognizes four small mounds rising from the surface of the underlying midbrain. To the early anatomists, the structures resembled little hills, called colliculi in Latin. One pair rises somewhat higher than the other, and thus was named the colliculi superior. The superior colliculi are composed of layers of nerve cells and nerve cell fibers. Three layers were shown to contain maps of our visual, acoustic and tactile space from the top to the bottom, respectively. The space maps normally overlap with great accuracy. As a consequence, the three senses permit us to localize an object in the same location with great precision. The congruence of spatial representation in three senses evolves during a critical period in brain development. Thirty years ago, Mazakasu Konishi and colleagues demonstrated a remarkable degree of plasticity in these maps in a series of elegant studies on barn owls in which the midbrain space representations realigned in compensation for manipulations of sensory input (Goldberg, 2008). Therefore, the recent observations in Switzerland do not come entirely as a surprise. A major focus of neurological research will remain on which additional functions are preserved after strokes that destroy visual cortex only partially.

Addenda

You may wish to read my post dated Dec. 18, 2007, on recovery of function after stroke (02/25/2009).

In her report on Reuters today, Maggie Fox describes a research study that provides evidence for improved recovery through visual exercise, perhaps aided by blind sight (04/01/09).

2 comments:

Dear William:Thank you very much for sharing your experience. I am glad that you can see again.

The points in time, when you started your therapies, are important for other people in a similar situation.

Among the three steps you took to regain vision, physiological stimulation may have contributed most. The brain tissue affected by the stroke may be divided into two regions: a core, in which nerve cells die owing to the permanent disruption of the blood supply, and a surround, known as the penumbra, affected by the extreme influx of fluid into the extracellular space (edema). Nerve cells in this region stop processing sensory input. The edema results in very high levels of the excitatory neurotransmitter glutamate which may trigger cell death. However, the edema subsides in the weeks after the stroke and some nerve cells will recover function. The recovery can be influenced with sensory stimulation. I suppose that happened in your case. I have written about such methods in my post dated Dec. 18, 2007 (see link in the Addendum above).

Supplying the brain with more oxygen may help. However, it is important not do begin this step too early. In the days after the stroke, blood flow is increased in the surround of the stroke to compensate for the loss of blood perfusion. Elevated concentrations of oxygen may lead to the production of free radicals. These are chemically very reactive molecules that may damage the nerve cells. After the blood flow readjusts to normal levels, a good oxygen supply may help the nerve cells to recover function.

It is hard to comment on your stem cell treatment without knowing specifics. But embryonic stem cells are known to play a neuroprotective role in animals.